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. 2012 May 31:1:26.
doi: 10.1186/2046-4053-1-26.

Interactions of commonly used dietary supplements with cardiovascular drugs: a systematic review

Salmaan Kanji  1 , Dugald Seely, Fatemeh Yazdi, Jennifer Tetzlaff, Kavita Singh, Alexander Tsertsvadze, Andrea C Tricco, Margaret E Sears, Teik C Ooi, Michele A Turek, Becky Skidmore, Mohammed T Ansari
Affiliations

Interactions of commonly used dietary supplements with cardiovascular drugs: a systematic review

Salmaan Kanji et al. Syst Rev. .

Abstract

Background: The objective of this systematic review was to examine the benefits, harms and pharmacokinetic interactions arising from the co-administration of commonly used dietary supplements with cardiovascular drugs. Many patients on cardiovascular drugs take dietary supplements for presumed benefits and may be at risk for adverse supplement-drug interactions.

Methods: The Allied and Complementary Medicine Database, the Cochrane Library, EMBASE, International Bibliographic Information on Dietary Supplements and MEDLINE were searched from the inception of the review to October 2011. Grey literature was also reviewed.Two reviewers independently screened records to identify studies comparing a supplement plus cardiovascular drug(s) with the drug(s) alone. Reviewers extracted data using standardized forms, assessed the study risk of bias, graded the strength of evidence and reported applicability.

Results: Evidence was obtained from 65 randomized clinical trials, 2 controlled clinical trials and 1 observational study. With only a few small studies available per supplement, evidence was insufficient for all predefined gradable clinical efficacy and harms outcomes, such as mortality and serious adverse events. One long-term pragmatic trial showed no benefit from co-administering vitamin E with aspirin on a composite cardiovascular outcome. Evidence for most intermediate outcomes was insufficient or of low strength, suggesting no effect. Incremental benefits were noted for triglyceridemia with omega-3 fatty acid added to statins; and there was an improvement in levels of high-density lipoprotein cholesterol with garlic supplementation when people also consumed nitrates

Conclusions: Evidence of low-strength indicates benefits of omega-3 fatty acids (plus statin, or calcium channel blockers and antiplatelets) and garlic (plus nitrates or warfarin) on triglycerides and HDL-C, respectively. Safety concerns, however, persist.

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Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Summary of evidence search and selection.
Figure 2
Figure 2
Omega-3 fatty acids co-administration with statins versus statins alone: post-treatment low density lipoprotein-cholesterol levels.
Figure 3
Figure 3
Omega-3 fatty acids co-administration with statins versus statins alone: post-treatment high density lipoprotein-cholesterol levels.
See this image and copyright information in PMC

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